The laparoscopic sleeve gastrectomy is considered a restrictive operation; however it also combines some of the metabolic advantages of the gastric bypass and biliary pancreatic diversion. Generally it appears to be best reserved as a standalone weight loss surgical procedure for patients whose BMI is less than 50.

Laparoscopic Gastric Sleeve/Vertical Sleeve GastrectomyIn appropriately selected patients the excess weight loss with vertical sleeve gastrectomy is approximately 60-65 percent of the excess weight. The sleeve gastrectomy also has been used as the first step in a staged operation for patients with BMI greater than 50.

This procedure is  performed solely on the stomach with no rerouting of the intestines. It has also been called Partial Gastrectomy, Vertical Sleeve Gastrectomy, and Gastric Sleeve. It basically consists of making a stomach look like a long tube; therefore the name “sleeve.”

In the procedure, two-thirds of the stomach is removed, which provides for quicker satiety (sense of fullness) and decreased appetite. The smaller stomach pouch restricts food intake by allowing only a small amount of food (3-4 ounces) to be eaten at one time.

After separation of the stomach into a smaller tube, the remainder of the stomach is removed. The pyloric valve at the outlet of the stomach remains; this provides for the normal process of stomach emptying to continue which allows for feeling full. Vomiting or discomfort can occur of  you eat too quickly, take large bites of food, drink fluids with meals/snacks, or eat dry, tough or sticky foods.

After surgery, an average meal should be one cup of food or less over the course of 30 minutes four to five times daily spaced 3-4 hours apart. Average weight loss depends on several factors, the most important being the patient’s compliance to their new diet. Other factors include the weight a patient started at, incorporating exercise and being more active, avoiding calorie-laden beverages and complying with medical therapy for other ailments.

Sleeve gastrectomy advantages

  • Typically the procedure is performed in less than an hour. 
  • It can be performed as a stand-alone restrictive procedure for a patient with a BMI under 50, who does not want their intestine bypassed or having a foreign body.
  • It can be a staged operation for patients with excessively high surgical risk and BMI. Staging procedures may reduce the risk of complications for the patient.
  • Often, most patients feel less hungry and are less interested in carbohydrates.
  • Average weight loss is between 50-70% of your excess weight.
  • The pyloric valve (outlet of the stomach) is still in place so patients will not usually experience dumping syndrome.

Sleeve gastrectomy disadvantages

  • Early nausea, feeling full or vomiting if you eat too quickly or too much.
  • Minor nutritional deficiencies, especially if patients are non-compliant with diet and supplements.
  • Because it is a restrictive procedure, average weight loss and resolution of comorbidities is slightly less than bypassing or rerouting the intestines.  
  • Over time the sleeve may dilate somewhat, which may contribute to regaining weight.
  • Managing a leak from a sleeve is more challenging than gastric bypass, although the risk is very small.

Gastric sleeve recovery timeline

  • Hospital stay is usually 24-48 hours.
  • Many patients return to normal activity within one to two weeks.
  • Full surgical recovery usually occurs within three weeks.
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